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� � � ` ,z� �� <br /> � �v <br /> City of Orono <br /> Building Permit Application �j �d <br /> � 8 <br /> for New Structures or Additions , <br /> Mailing Address: ,=, , �'`"*`; <br /> ��A,O PO Box 66 Permit number: '.�, � ' �_, ' i.,:� <br /> `V Crystal Bay, MN 55323-0066 Date received: ��/ `. <br /> StreetAddress:' Received by: c_��/c'�i_`1 ' <br /> �" � 2750 Kelley Parkway ! ' `, - • <br /> y � � �l�i�Y�(� �'�l Plan reviewfee: � ,' ' ���_-/C`� t �` �.� <br /> F! ��` Orono, MN 55356 ._ �,�� _ _ _ _ <br /> _ __ --- <br /> , _._ _ <br /> �kEg}{O� Main: 952-259-4600 " T Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> r . � .. �. , <br /> Job Site Address: ���,� 4..ti `��'` <br /> ^ � ' �.. �:;�.If_• �jr..�..'�,�1'�.i rr�1�.i )._7 _,/.]" <br /> Will this be a Parade of Homes, Rem elers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service i be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRA�TOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INF RMATION: ..�- <br /> Name: �` �� - Y7 Q. `�' �J �Q... -�'_�YL��G�-y <br /> Phone (day): n� � � }� �r1 <br /> Address: ^�, � �� Cit : t,�'�►'�b ZIP: 5�.��`�• <br /> Email and/or Fax ,� �' � itj , C.�>�Y�l <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: _ ___ <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> �'Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial �Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse � <br /> ❑ Public Storage -� ; � "" ❑ Public Water <br /> "*Any earth movement may require ❑ Commercial Other(specify) <br /> MCWD review 8� permits. ❑ Industrial �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (Specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> U'.� <br /> Estimated Construction Valuation (excluding land) � ���r� . 5J� <br /> Packet Last Updated: 04/19/20?3 ba� <br /> Page 22 of 23 / <br />